JACR: Rads' documentation of communicated findings rises
 |
The study was initiated in response to a report published by the Institute of Medicine as well as other academic research that documented the high number of medical error-related deaths in the U.S., many of which had been the result of delayed responses by practitioners to critically abnormal test results.
These reports, the authors insisted, led a number of agencies and organizations, such as the American College of Radiology (ACR) and the Joint Commission, to push for improved communication of test results between radiologists and other physicians, including encouraging radiologists to document or provide evidence as to whether they had communicated critical test results directly to healthcare providers.
Paras Lakhani, MD, and Curtis P. Langlotz, MD, PhD, of the department of radiology at the Hospital of the University of Pennsylvania in Philadelphia, used text-mining algorithmic software to analyze nearly 2.3 million radiology reports written between 1997 and 2005 at the Hospital of the University of Pennsylvania.
The text-mining software looked for specific combinations of words and phrases that indicate documented communication of findings between the reporting radiologist and the healthcare provider. The algorithm had demonstrated 98 percent accuracy in a previous study.
The authors found that by the end of the eight-year investigation period, the percent of radiology reports documenting that the findings had been communicated to healthcare providers had risen from 3.04 to 6.82 percent.
The study also found that documentation of communication had risen for four of the most utilized testing modalities: CT rose by 67 percent, MRI by 83 percent, computed radiography by 113 percent and ultrasound by 19 percent. Still, none of these most common modalities reached a rate of documented communication between radiologists and primary physicians of 15 percent, with CT’s 14 percent documentation rate being the highest among the common modalities.
Radiologists most frequently documented that they had communicated test results with primary providers after neuroangiography procedures, in which communication was documented after 29 percent of tests.
Lakhani and Langlotz also randomly selected 200 reports that had documented communication of findings for manual review. Of the 200 reports, 155 revealed critical or discrepant results were discovered, in which the findings indicated that patients were at risk of mortality or morbidity, or that diagnosis and treatment were significantly different from the preliminary interpretation.
The authors hypothesized that three factors helped account for the increased documentation of communicated findings by radiologists. The first was an increased adherence to ACR guidelines, which are widely followed and important for accreditation. The second reason that radiologists increased their documentation, the authors speculated, was because doing so may help shield radiologists from accusations of negligent care and malpractice suits. Finally, the authors argued that mere encouragement by hospital faculty had had an effect on radiologists’ documentation rates.
The study acknowledged that, despite the large sample of reports, the fact that all reports came from the Hospital of the University of Pennsylvania may limit how well the findings represent physicians’ rates of documentation at other hospitals.
The authors also emphasized the importance of developing an algorithm that could detect whether communicated and non-communicated findings were critical or uncritical. Such a program, which the authors are currently designing, could help control quality and responsiveness of physicians to critical findings and thereby improve patient care, the authors claimed.